Circumcision: Pros and Cons

For those of you who are looking to have children, mainly a boy, then you have most likely had the discussion with your partner about whether or not to circumcise your child. Whether it be for a spiritual or religious motivation or whether or not it is for hygiene. No matter how you look at it the topic elicits questions spanning from sexual health to cultural or religious worthiness. When it comes to your own health some men marvel if being circumcised is advantageous to their health or if it would make sexual intercourse more comfortable and joyous. These men often have discomfort when the foreskin is drawn back or retracted. Many men also even feel that their female partners would value them more if they were to undergo a circumcision, if they weren’t already, as an adult. Also, if it will ameliorate sexual health concerns such as premature ejaculation or erectile dysfunction. Another facet is if a circumcision will improve hygiene, or make them less prone to sexually transmitted diseases or infections.

Before we cover some of the questions above let’s take a look at the current and traditional aspects of circumcision and expand on the numerous types of studies that were conducted and how it effects a man’s health. The premise of this piece is not to provide a bias, more to provide insight on a topic that many of us either have thought about our own health or will eventually think about when becoming a new parent. Please consult your doctor or family physician for further information, the general information provided is not to diagnose or treat any medical condition or provide medical advice.

Religious and Cultural Facets

The act of Circumcision dates back as far as 5000 years and is portrayed in early Egyptian writings. In some societies and cultures circumcision is mainly a form of a religious rite, whereas in others it may be a traditional or a cultural practice. Circumcision is mandatory and compulsory for Jews. It is also stated explicitly by God to Abraham as a sign of the covenant in the Old Testament that Prophet Abraham and his successors must be circumcised (see Gen. 17:10-14).

In Islam, circumcision is practised, and performed only to conform to the practice of the Prophet Mohammad and is not a religious necessity. Even in the sayings of Prophet Mohammad, the references date back to the practice of Prophet Abraham. Over time, circumcision has become an important tradition in the socio-cultural life of Muslims and is practised by almost all of Muslim community.

Medical Reasons for Circumcision

The procedure of circumcision is a surgical removal, performed by a medical professional of partial or of complete foreskin or prepuce which is the loose fold of skin covering the tip of the penis. Circumcision may be undergone at any stage; infancy, childhood, adolescence or even adulthood. Many societies have been practising circumcision for hundreds of years and it is often seen as a mark of hailing from or belonging to a specific tribe or religious group.

There is substantial controversy that exists over whether the procedure has any medical health benefits. Some studies suggest that circumcision is associated with a reduced risk of Human Immunodeficiency Virus or commonly known as HIV. And a reduced risk of Infections such as Urinary Tract Infections (UTI’s). Studies show that early circumcision substantially reduces the risk of urinary tract infections in young males. These studies also suggest that the probability of urinary infections in uncircumcised boys is 10 times higher than that of the circumcised boys. The probability of sexually transmitted diseases (STD’s) is almost cut in half and the risk of developing Penile Carcinoma is almost zero in circumcised males.

For females, it reduces the risk of Cervical Cancer, as the risk of Cervical Cancer in partners of circumcised males is exceedingly low as is evident and obvious in Jewish and Muslim communities. The risk of Genital Ulcerations, Bacterial Vaginosis, Trichomoniasis and Human Papillomavirus (HPV) are also decreased considerably.

Circumcision also reduces or prevents problems related to the foreskin, as to say Phimosis, Paraphimosis, or Balanitis. Those who oppose these findings believe that the procedure may have adverse effects on sexual, emotional, or psychological health. They also suggest that the foreskin is highly sensitive and plays an important role in lubrication during sexual intercourse.

That said, circumcised men do have an increased risk of suffering from Meatitis; which is inflammation to the opening of the penis as it is exposed.

Circumcision and HIV

Since the 1980’s, scientists have suspected that male circumcision might reduce the rate of HIV transmission during sexual intercourse. They observed that circumcised men are less likely to have HIV than uncircumcised men, and HIV is less common among populations that traditionally practice male circumcision than in communities where the procedure is seldom performed or practised.

However, this was a hypothesis and for long it remained ill-defined to what degree that this was an effect of circumcision itself or whether numerous other factors might also play a part.

To try settling this issue, three trials were set up in sub-Saharan Africa involving more than 11,000 previously uncircumcised men. Each male participant was assigned to one of the two categories: the first being a group that had their foreskins removed at the start of the study and the second were others who remained uncircumcised throughout. All the men involved received extensive training and counselling on HIV prevention and protection as well as risk reduction measures. During the trials, researchers gathered information about the men’s sexual behaviour to document whether it varied between the two groups; however, they found no significant differences.

The circumcision trials in Kenya and Uganda came to a end on December 12, 2006, after an expert panel decided that it would be immoral to commence with the trials. They decided that there was already sufficient evidence proving that circumcision helps to reduce the risk of HIV infection. The results of the circumcision trials were as follows:

the above data shows that male circumcision, if performed safely by a practitioner, cuts the risk of becoming infected with HIV through heterosexual sex in half.

How Does Circumcision help to Prevent HIV?

There are several ways in which the foreskin acts as HIV’s main ‘entranceway’ during penetrative sex between an uninfected man and an HIV-infected partner. The inner surface of the foreskin contains a greater proportion of the cells that HIV targets, which are called T-cells. The inner foreskin possesses less keratin which is a protein found in the skin and has a protective effect. The study of Ugandan men before and after undergoing circumcision revealed a decrease in anaerobic bacteria may play a role in reducing the risk of HIV. Circumcision may also reduce the likelihood of genital ulcers, which increase the risk of being infected with HIV. Any small tears in the foreskin that occur during sexual intercourse make any invasion of a virus or infection easier to access the body through open sores and then directly travels through the blood stream throughout the body.

The World Health Organization describes health as being “not merely physically healthy, but also to be psychologically and socially healthy.” The organization states that circumcision is not a sure-fire guarantee of protection from HIV infection. Even though the trials concluded that infection of the virus was 60% lower in men who underwent circumcision; there was little evidence explaining how circumcision causes a declination of a man’s risk of being infected with HIV.

Circumcision and Prostate Cancer

A research study undergone in Montreal, Quebec concluded that men circumcised after 35 years of age were just about 45% less likely to develop prostate cancer while uncircumcised men were at greater risk. This study was conducted by Andrea Spence and her research directors Marie Élise Parent and Marie-Claude Rousseau (Researchers at the University of Montreal and the INRS – Institut Armand-Frappier). In this study, 2114 men residing on the Island of Montreal were interviewed; roughly half of them were diagnosed with prostate cancer during 2005-2009. The remainder of men were a form of a case-control to the experiment so the researchers could compare their findings. The interview comprised of questions relevant to their lifestyle as well as whether they were circumcised or uncircumcised and at what age they underwent circumcision.

Random Facts

Circumcised men are 11% less likely to develop Prostatic Adenocarcinoma (Prostate cancer ~ A malignant tumour which is almost always an Adenocarcinoma of the prostate gland).

Infants who underwent circumcision younger than 1 year old were 14% less likely to develop prostate cancer older in life as the removal of the prepuce at a young age provides protection against various forms of penile and prostate cancer.

Prostate cancer is rare amongst Jewish or Muslim as circumcision as a common practice.

Three primal risk factors of prostate cancer are: ageing, a family history (of prostate cancer), and individuals from Black African ethnic origins.

Out of 178 Black men who participated in a study (78% were Haitian origin) the probability of developing prostate cancer was 1.4 times higher than White men. 30% of Black men were circumcised compared to 40% of White men. Surprisingly, the risk of Black men developing prostate cancer declined by 60%.

Circumcision and Penile Cancer

Also relating to the Penile Bacterial ecosystem. There is a strong link between Human Papilloma Virus (HPV) and penile cancer. HPV is a virus that is passed through sexual contact either vaginal or anal sex and can be transmitted by both men and woman without even knowing or experiencing any symptoms. Studies show that infant circumcisions help reduce the risk of penile cancer in men at a later age. Those who are not circumcised can take preventative measures by practising appropriate hygiene while cleaning the penis. Circumcision does effectively alter the Penile Bacterial ecosystem as it has an effect on Aerobic (need oxygen to survive) and Anaerobic (thrive on low concentrations of oxygen) bacteria. Both are types of bacteria that allow infections and diseases to grow and mutate.

In short, as you may have noticed the pros of male circumcision seem to outweigh the cons. There is no definitive explanation for the reasons why circumcision reduces the risk of HIV and the various forms of cancer that effect men. As topic of circumcision remains evident it is difficult to cover everything in relevance, whether beneficial or harmful, without the continued research collected from trials and studies. Please consult your physician if you have any specific questions or inquiries as it relates to your health condition and I hope that the information that I have provided will help you when inquiring with your physician on what’s best for yourself and your family.

Share your thoughts with us regarding Circumcision!

Some questions to consider:

Do you agree or disagree with circumcising your child?

Do you feel that there are no health benefits related to being circumcised?

If you are not currently circumcised, have you been considering the procedure?

If you would like to share your thoughts please leave a comment below.

About Zeeshan Hussain

I am a Medical Observer at First Affiliated Hospital of Xinjiang Medical University and an English Language Trainer at Beijing Century Consulting & Service Co. Ltd. I am passionate about healthy living and providing insight to others from my knowledge and experience. Maybe we can all influence healthy changes in each others day to day lives. Enjoy!

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